Temporal and spatial trends of fentanyl co-occurrence in the illicit drug supply in the United States: a serial cross-sectional analysis.

Background: Fentanyl and its analogs contribute substantially to drug overdose deaths in the United States. There is concern that people using drugs are being unknowingly exposed to fentanyl, increasing their risk of overdose death. This study examines temporal trends and spatial variations in the co-occurrence of fentanyl with other seized drugs. Methods: We identified fentanyl co-occurrence (the proportion of samples of non-fentanyl substances that also contain fentanyl) among 9 substances or substance classes of interest: methamphetamine, cannabis, cocaine, heroin, club drugs, hallucinogens, and prescription opioids, stimulants, and benzodiazepines. We used serial cross-sectional data on drug reports across 50 states and the District of Columbia from the National Forensic Laboratory Information System, the largest available database on the U.S. illicit drug supply, from January 2013 to December 2023. Findings: We analyzed data from 11,940,207 samples. Fentanyl co-occurrence with all examined substances increased monotonically over time (Mann-Kendall p < 0.0001). Nationally, fentanyl co-occurrence was highest among heroin samples (approx. 50%), but relatively low among methamphetamine (≤1%), cocaine (≤4%), and other drug samples. However, co-occurrence rates have grown to over 10% for cocaine and methamphetamine in several Northeast states in 2017-2023. Interpretation: Fentanyl co-occurs most commonly with heroin, but its presence in stimulant supplies is increasing in some areas, where it may pose a disproportionately high risk of overdose. Funding: This work was partly supported by FDA grant U01FD00745501. This article reflects the views of the authors and does not represent the views or policies of the FDA or US Department of Health and Human Services.

Success rate and complications of performing elective ureteroscopy in <1 week versus over 1 week from renal colic initiation in ureteral stones larger than 6 mm.

Background: The aim of this study was to compare the outcomes, success rate, and complications of performing elective ureteroscopy at different times: <1 week from renal colic initiation (early) and more than 1 week from renal colic initiation (late) in patients with ureteral stone larger than 6 mm. Materials and Methods: This comparative observational study was conducted on 338 consecutive patients. Patients were evaluated in two groups: patients who underwent ureteroscopy in <1 week (A) and patients who underwent ureteroscopy in more than 1 week (B) from renal colic initiation. Helical unenhanced computed tomography was used to assess the size, location, and hardness of stone for all patients. Operation success was defined as complete clearance of stone with no stone residue (stone free) at 2-week postoperative ultrasonography with no need to further interventions. Operation data were collected using medical records, and postoperative complications were investigated at 2 weeks postoperative follow-up visits. Results: Group A included 165 patients and Group B included 173 patients. The overall mean stone size was 8.60 ± 1.12 mm: for Group A 9.13 ± 0.94 mm and for Group B 8.10 ± 1.04 mm (P < 0.001). Stone residues were found in 11 patients: 9 in Group A (5.4%) and 2 in Group B (1.1%) (P = 0.026). Nine patients needed repeated ureteroscopy: 8 (4.8%) in Group A and 1 (0.6%) in Group B (P = 0.015). A double-J stent was used for 85 (51.5%) patients in Group A and 66 (38.2%) patients in Group B (P = 0.016). Major intraoperative complications did not happen in any patients. Fifty-three (32.1%) patients in Group A and 28 (16.2%) patients in Group B suffered from postoperative complications (P = 0.001). Conclusion: Our study revealed that performing elective ureteroscopy with an interval of more than 1 week from the onset of renal colic in combination with medical treatments was associated with less need for double-J stent placement, less need for repeated ureteroscopy, and fewer postoperative complications compared to performing elective ureteroscopy in <1 week from the renal colic onset in nonemergent patients with ureteral stone larger than 6 mm. Although the rate of ureteroscopy failure was higher among the patients who underwent ureteroscopy in <1 week from their renal colic initiation, there was no statistically significant relationship between performing ureteroscopy in <1 week and an increased risk for ureteroscopy failure.

Graph-based Analysis to Predict Repetitive Transcranial Magnetic Stimulation Treatment Response in Patients With Major Depressive Disorder Using EEG Signals.

Introduction: Repetitive transcranial magnetic stimulation (rTMS) is a non-pharmacological treatment for drug-resistant major depressive disorder (MDD) patients. Since the success rate of rTMS treatment is about 50%-55%, it is essential to predict the treatment outcome before starting based on electroencephalogram (EEG) signals, leading to identifying effective biomarkers and reducing the burden of health care centers. Methods: To this end, pretreatment EEG data with 19 channels in the resting state from 34 drug-resistant MDD patients were recorded. Then, all patients received 20 sessions of rTMS treatment, and a reduction of at least 50% in the total beck depression inventory (BDI-II) score before and after the rTMS treatment was defined as a reference. In the current study, effective brain connectivity features were determined by the direct directed transfer function (dDTF) method from patients' pretreatment EEG data in all frequency bands separately. Then, the brain functional connectivity patterns were modeled as graphs by the dDTF method and examined with the local graph theory indices, including degree, out-degree, in-degree, strength, out-strength, in-strength, and betweenness centrality. Results: The results indicated that the betweenness centrality index in the Fp2 node and the δ frequency band are the best biomarkers, with the highest area under the receiver operating characteristic curve value of 0.85 for predicting the rTMS treatment outcome in drug-resistant MDD patients. Conclusion: The proposed method investigated the significant biomarkers that can be used to predict the rTMS treatment outcome in drug-resistant MDD patients and help clinical decisions.

Factor structure and psychometric properties of the Body Perception Questionnaire-Short Form (BPQ-SF); The Persian version.

BACKGROUND: Body perception is considered an important physiological marker in physical and mental disorders, therefore, its valid and reliable quantification is indeed necessary. Due to the lack of a Persian version of an instrument with validated psychometric properties for evaluating body perception, this study aimed to investigate the factorial structure, reliability, and validity of body perception questionnaire-Short Form (BPQ-SF) among Iranian adults. METHODS: A total of 748 participants (mean age = 31.74; 57%female) were included in the analysis. Participants were recruited using the online survey method. Confirmatory factor analysis (CFA) was performed and concurrent validity was determined by computing Pearson's correlation coefficient between BPQ_SF, Depression Anxiety Stress Scale (DASS), and somatization subscale of Symptom-Checklist-90 (SOM). Internal consistency (using Cronbach's alpha and McDonald's omega), and composite reliability were also evaluated. RESULTS: The result of the CFA yielded three factors: Body Awareness, Subdiaphragmatic Reactivity, and Supradiaphragmatic Reactivity. Cronbach's alpha values for all BPQ_SF items were 0.94. Moreover, Concurrent validity between BPQ, SOM, and DASS was determined to be between 0.44 to 0.94. and had good internal consistency (McDonald's Omega range: .74-.93 Cronbach's alpha range: .76-.94). CONCLUSIONS: The BPQ-SF demonstrated good psychometric properties among Iranians thus can be used to reliably assess body perception.

Color and brightness at work: Shedding some light on mind wandering.

INTRODUCTION: Occupational hazards are partly caused by the physical factors of the work environment, among which are ambient color and brightness, which can interfere with cognitive performance. Especially in modern work environments, performance relies heavily on cognitive functions such as attention, and an important factor in disrupting sustained attention is mind wandering (MW). This study aimed to investigate the effects of white and blue colors with two brightness levels on sustained attention and brain electrophysiology. METHODS: A total of 20 participants were exposed to 4 different conditions (white and blue as color and 300 and 800 lx as the brightness level) in separate blocks in a virtual reality environment in which a continuous performance test (CPT) was performed. RESULTS: The high brightness blue condition induced significant changes in sustained attention. MW network analysis showed a significant decrease in delta frequency band in the blue color condition with high brightness and beta decrease in the blue color condition with low brightness, whereas the activity of MW network increased when exposed to the white color condition. CONCLUSION: High-brightness blue light resulted in better sustained attention and decreased activity of MW-related neural regions. It is thus recommended that these results be taken into consideration in the interior design of educational settings and cars among other environments that require a high level and maintenance of cognitive functions, especially sustained attention.

Metaanalysis of Repetitive Transcranial Magnetic Stimulation (rTMS) Efficacy for OCD Treatment: The Impact of Stimulation Parameters, Symptom Subtype and rTMS-Induced Electrical Field.

Background: Repetitive transcranial magnetic stimulation (rTMS) has recently demonstrated significant potential in treating obsessive-compulsive disorder (OCD). However, its effectiveness depends on various parameters, including stimulation parameters, OCD subtypes and electrical fields (EFs) induced by rTMS in targeted brain regions that are less studied. Methods: Using the PRISMA approach, we examined 27 randomized control trials (RCTs) conducted from 1985 to 2024 using rTMS for the treatment of OCD and conducted several meta-analyses to investigate the role of rTMS parameters, including the EFs induced by each rTMS protocol, and OCD subtypes on treatment efficacy. Results: A significant, medium effect size was found, favoring active rTMS (gPPC = 0.59, p < 0.0001), which was larger for the obsession subscale. Both supplementary motor area (SMA) rTMS (gPPC = 0.82, p = 0.048) and bilateral dorsolateral prefrontal cortex (DLPFC) rTMS (gPPC = 1.14, p = 0.04) demonstrated large effect sizes, while the right DLPFC showed a significant moderate effect size for reducing OCD severity (gPPC = 0.63, p = 0.012). These protocols induced the largest EFs in dorsal cognitive, ventral cognitive and sensorimotor circuits. rTMS protocols targeting DLPFC produced the strongest electrical fields in cognitive circuits, while pre-supplementary motor area (pre-SMA) and orbitofrontal cortex (OFC) rTMS protocols induced larger fields in regions linked to emotional and affective processing in addition to cognitive circuits. The pre-SMA rTMS modulated more circuits involved in OCD pathophysiology-sensorimotor, cognitive, affective, and frontolimbic-with larger electrical fields than the other protocols. Conclusions: While rTMS shows moderate overall clinical efficacy, protocols targeting ventral and dorsal cognitive and sensorimotor circuits demonstrate the highest potential. The pre-SMA rTMS appears to induce electrical fields in more circuits relevant to OCD pathophysiology.

Prevalence of acute kidney injury following percutaneous nephrolithotomy.

Background: The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure. Materials and Methods: From May 2022 to October 2022, we conducted a retrospective study on patients undergoing PCNL procedures in two of the tertiary medical centers affiliated with Isfahan University of Medical Sciences. Patients' baseline characteristics, laboratory values, perioperative data, and stone features were documented. AKI was defined either as a ≥0.3 mg/dL increase in the serum creatinine level within 2 days, or a ≥1.5-fold increase in baseline serum creatinine level within 7 days after the operation. Laboratory values were measured 1 day before PCNL and daily thereafter until discharge. Patients were followed 1 week later to detect all of the possible cases of AKI. Results: The final analysis was performed on 347 individuals. AKI developed in 16 (4.61%) cases. The two groups were comparable regarding age (P = 0.887), gender (P = 0.566), and underlying comorbidities including diabetes mellitus (P = 0.577) and hypertension (P = 0.383). The mean body mass index (BMI) (P < 0.001) and both frequency and severity of hydronephrosis (P < 0.001) were significantly different. A higher mean PCNL duration (P < 0.001), period of hospitalization (P < 0.001), and blood loss volume (P < 0.001) were observed in those who developed AKI. Overall, 56.3% (9) of patients in the AKI group and 2.7% (9) in the non-AKI group required the establishment of more than one access tract, during the procedure (P < 0.001). A lower preoperative hemoglobin level was observed in the AKI group (P < 0.001). Those with AKI had significantly larger stones (3.08 ± 0.46 vs. 2.41 ± 0.23 cm, P < 0.001) and higher Hounsfield units (P < 0.001). In addition, in the AKI group, most of the calculi (81.3%, 13) were of staghorn type, whereas in the non-AKI group, calculi were most frequently located in the middle calyx (30.2%, 100), (P < 0.001). Conclusion: The prevalence of post-PCNL AKI is approximately 4.61%. The mean BMI, preoperative hemoglobin level, PCNL duration, intraoperative blood loss volume, and hospitalization period were significantly higher among patients who developed AKI. Those with AKI had significantly larger stones with higher Hounsfield units and more frequently of staghorn type. The two groups were not statistically different regarding age, gender, and presence of comorbidities (hypertension and diabetes mellitus).

Primary ureteral adenocarcinoma in a patient with previous gastric adenocarcinoma: a rare nonmetastatic case.

Upper urinary tract adenocarcinoma is a rare malignancy with a challenging diagnosis and limited treatment options. This paper presents a rare case of primary ureteral adenocarcinoma, an exceptionally uncommon malignancy typically associated with genitourinary or extra-genitourinary tumors. The 53-year-old patient, with a history of gastric adenocarcinoma and prior chemotherapy, developed left flank pain. Imaging revealed a tumor in the distal ureter, leading to a left radical nephroureterectomy. Histopathology confirmed an intestinal-type adenocarcinoma of the upper urinary tract. Unique to this case, the adenocarcinoma originated separately from the stomach. Despite planning adjuvant chemotherapy, the patient's deteriorating condition led to palliative care, and he passed away three months post-diagnosis. The paper underscores the challenges in diagnosing and treating such rare malignancies, emphasizing the need for further research to understand their etiology and optimal management.

Female Cerebellum Seems Sociable; An iTBS Investigation.

The cerebellum has been shown to be engaged in tasks other than motor control, including cognitive and affective functions. Prior neuroimaging studies have documented the role of this area in social cognition and despite these findings, no studies have yet examined the causal relationship between the cerebellum and social cognition. This study aimed to investigate the role of the cerebellum in empathy and theory of mind (ToM) in a randomized, placebo-controlled, double-blind, parallel study. 32 healthy participants were assigned to either a sham or active group. For the active group, an intermittent theta-burst stimulation (iTBS) protocol at 100% of the motor threshold was applied to the cerebellum, while the control group received sham stimulation. An eyes-closed EEG session, the Empathy Quotient (EQ) test, and the Reading the Mind in the Eyes Test (RMET) were administered before and after the iTBS session. The results demonstrated differences in cognitive empathy, ToM, and a decrease in the activity of the default mode network (DMN) between the active and sham groups in females. Females also showed a decrease in the activity of the affective empathy network and connectivity in the DMN. We conclude that cognitive empathy and ToM are associated with cerebellar activity, and due to sex-related differences in the cortical organization of this area which is modulated by sex hormones, the stimulation of the cerebellum in males and females yields different results.

Association between dietary phytochemical index and risk of benign prostatic hyperplasia: a case-control study.

BACKGROUND: Dietary intake of phytochemicals has been associated with a reduced risk of chronic diseases, but research on their relationship with benign prostatic hyperplasia (BPH) is limited. This case-control study aimed to investigate the association between a Dietary Phytochemical Index (DPI) and BPH risk in a Middle-Eastern population. METHODS: The study recruited 112 BPH patients and 112 age-matched healthy controls (40-75 years) from Al-Zahra Hospital Clinic in Isfahan, Iran between 2021 and 2022. Dietary intake was assessed using a validated food-frequency questionnaire, and DPI was calculated as the ratio of energy intake from phytochemical-rich foods to total daily energy intake. Logistic regression analysis was performed, adjusting for potential confounders. RESULTS: In the crude model, participants in the highest DPI tertile had a 70% lower odds of BPH compared to those in the lowest tertile (OR:0.3, 95% CI 0.15-0.61, P-trend = 0.001). After adjusting for confounders, this inverse association remained significant (OR:0.23, 95% CI 0.15-0.63, P-trend = 0.001). Participants with higher DPI consumed more whole grains (p = 0.02), nuts (p < 0.001), legumes (p = 0.02), fruits (p < 0.001), vegetables (p < 0.001), olives and oilve products (p = 0.02), and tomato and its products (p < 0.001) in their diet compared to the lowest tertile. However, red meat (p = 0.03) and refined grains (p < 0.001) were consumed in higher amounts in the lowest tertile compared to the highest DPI tertile. CONCLUSIONS: This study demonstrates a protective association between DPI and BPH risk in the Middle-Eastern population. Encouraging higher intake of phytochemical-rich foods may help reduce the risk of BPH, highlighting the relevance of nutritional science in promoting prostate health.

Acute liver injury and contralateral pleural effusion as two rare complications following percutaneous nephrolithotomy: a case report.

INTRODUCTION: Percutaneous Nephrolithotomy (PCNL) is a widely used surgical intervention for removing large and complex renal calculi. While considered a safe and effective procedure, it can still lead to severe and rare complications, including bleeding, pulmonary complications, and liver dysfunction. CASE PRESENTATION: This case report presents a case who underwent PCNL for a kidney stone and subsequently developed a series of rare and severe complications. Following the PCNL procedure, the patient experienced significant bleeding, a known but uncommon complication of PCNL, pulmonary complications, a common complication that may carry a risk of death, and acute liver failure, an exceedingly rare consequence of PCNL. CONCLUSION: In summary, while PCNL is a valuable technique for treating kidney stones, it is not without risk. This case underscores the importance of recognizing and managing rare complications following PCNL surgery, highlighting the need for vigilance, multidisciplinary care, and timely interventions to ensure favorable patient outcomes.

Brain stimulation for patients with multiple sclerosis: an umbrella review of therapeutic efficacy.

Multiple sclerosis patients often experience various symptoms that can greatly impact their quality of life. There are various brain stimulation techniques that have been evaluated for their ability to reduce the symptoms of multiple sclerosis. However, there is inconsistency in the specific stimulation methods used and the symptoms targeted in the existing research. This umbrella review conducted in order to evaluate the effectiveness of brain stimulation and identify limitations and gaps for further research. In this umbrella review, we conducted a searched on Web of Knowledge, PubMed, and Scopus database. We specifically looked for reviews, with or without meta-analyses, that have investigated the effects of brain stimulation methods on symptoms of multiple sclerosis. All articles were examined by AMSTAR 2 (A Measure Tool to Assess Systematic Review 2). We identified 155 articles, of which 14 were eligible for inclusion. Of those, five were qualitative studies and nine were meta-analyses. Among the included studies, four examined the use of deep brain stimulation, while ten investigated the therapeutic potential of noninvasive brain stimulation. Considering the heterogeneity of studies, the current evidence suggests that repetitive transcranial magnetic stimulation may be effective in treating pain and improving motor function, while transcranial direct current stimulation may be useful in alleviating fatigue and enhancing certain aspects of cognitive performance. Deep brain stimulation, on the other hand, appears to be effective in reducing tremors. However, further research is warranted to validate these findings and address the existing limitations in the field.

Effect of acupressure on pain among older female patients undergoing extracorporeal shock wave lithotripsy: A randomized controlled clinical trial.

BACKGROUND AND AIM: Urinary stones are highly prevalent among older people. Extracorporeal lithotripsy is one of the commonly used treatment methods, but it causes pain. Acupressure is a non-pharmacological therapeutic method that is effective in relieving pain among patients with various health conditions. This study aimed to investigate the effect of acupressure on pain among female older people undergoing extracorporeal lithotripsy. METHOD: This randomized controlled clinical trial was conducted on 66 older female patients undergoing extracorporeal lithotripsy. They were enrolled in the study through convenient sampling and were assigned to the intervention and control groups through the block randomization method. The intervention group underwent acupressure for 16 min which was repeated twice with an interval of 20 min, but the control group received only touch without any pressure for the same period. The McGill Pain Questionnaire and Visual Analogue Scale were completed 60 min before the intervention and immediately after lithotripsy. FINDINGS: Before the intervention, no statistically significant difference in the quality and intensity of pain between the two groups was observed (p > 0.05). However, after acupressure, the mean scores of quality and intensity of pain decreased significantly (p < 0.001) in the intervention group compared with the control group. CONCLUSION: Acupressure as a complementary and alternative medicine can reduce pain and suffering among older people undergoing extracorporeal lithotripsy. It can be included in the routine therapeutic measures for relieving pain and suffering during noninvasive methods for older people and reducing their need for medication use and avoiding related pharmacological side effects.

Targeting the insula with transcranial direct current stimulation; A simulation study.

Insula is considered an important region of the brain in the generation and maintenance of a wide range of psychiatric symptoms, possibly due to being key in fundamental functions such as interoception and cognition in general. Investigating the possibility of targeting this area using non-invasive brain stimulation techniques can open new possibilities to probe the normal and abnormal functioning of the brain and potentially new treatment protocols to alleviate symptoms of different psychiatric disorders. In the current study, COMETS2, a MATLAB based toolbox was used to simulate the magnitude of the current density and electric field in the brain caused by different transcranial direct current stimulation (tDCS) protocols to find an optimum montage to target the insula and its 6 subregions for three different current intensities, namely 2, 3, and 4 mA. Frontal and occipital regions were found to be optimal candidate regions.. The results of the current study showed that it is viable to reach the insula and its individual subregions using tDCS.

Knee Extension Exercise Effects on Physiological and Psychophysical Performance: Normal Weight Versus Obese Office Workers.

BACKGROUND: Knee extension exercise is useful and practical for obese and overweight people as this form of exercise is effective in minimizing body weight loading on joints and improving the body's physiological function. This study aimed to compare the physiological and psychophysical parameters of office workers while computer-based working in an active workstation equipped with an active footrest (AFR) prototype with a mechanism for performing knee extension exercises in a sitting position, and also to compare the physiological and psychophysical parameters among normal-weight and obese office workers. METHODS: In this quasi-experimental study, the physiological parameters of heart rate (HR) and energy expenditure (EE) (measured with the Fitbit Charge HR smartwatch) were measured in two cross-over random sessions for 32 office workers (16 normal-weight and 16 obese) aged 28 to 50 years (M = 42.72, standard deviation [SD] = 4.37) while performing office tasks in sitting and active workstations (equipped with AFR). Perceived physical exertion, comfort, fatigue, and liking were also measured by rating the participants. FINDINGS: Short-term activity of the participants with AFR performing computer tasks significantly improved physiological and psychophysical parameters compared with the participants in sitting workstations. However, there was no significant difference in the effect of AFR on physiological and psychophysical parameters between normal-weight and obese participants. CONCLUSIONS/APPLICATION TO PRACTICE: Given the significant increase in EE and HR resulting from exercise with AFR compared with the conventional workstation, the use of AFR can help office workers achieve the minimum standard of physical activity at their workplace.

Effectiveness of Bromelain in the control of postoperative pain after periodontal surgery: A crossover randomized clinical trial.

Background: This study aimed to compare the analgesic effects of Ibuprofen and bromelain after periodontal surgery. Methods: A double-blinded crossover clinical trial was conducted on 22 patients needing two crown lengthening surgeries without bone surgery or with limited bone surgery on two quadrants of the maxilla, with control and test sides. Each quadrant was randomly assigned to bromelain (500 GUD) or ibuprofen (400 mg). Immediately after the surgery and 6 hours after it, the first dose of the drugs was packaged in the same capsules in A and B. Postoperative pain was evaluated during the first 8 hours and on the following day using a visual analog scale (VAS). Results: Using the VAS, the Ibuprofen group showed significantly lower mean pain scores than the bromelain group at 4 hours (P=0.047). In contrast, there were no significant differences between the two groups at 2, 6, 8, 10, 12, 24, and 48 hours (P>0.05). Conclusion: The effectiveness of bromelain for pain control following periodontal surgery was comparable to that of Ibuprofen. Therefore, bromelain can be an efficient replacement for ibuprofen in managing pain after periodontal surgery, especially in patients with gastric ulceration and increased bleeding tendency.

A convolutional recurrent neural network with attention for response prediction to repetitive transcranial magnetic stimulation in major depressive disorder.

Prediction of response to Repetitive Transcranial Magnetic Stimulation (rTMS) can build a very effective treatment platform that helps Major Depressive Disorder (MDD) patients to receive timely treatment. We proposed a deep learning model powered up by state-of-the-art methods to classify responders (R) and non-responders (NR) to rTMS treatment. Pre-treatment Electro-Encephalogram (EEG) signal of public TDBRAIN dataset and 46 proprietary MDD subjects were utilized to create time-frequency representations using Continuous Wavelet Transform (CWT) to be fed into the two powerful pre-trained Convolutional Neural Networks (CNN) named VGG16 and EfficientNetB0. Equipping these Transfer Learning (TL) models with Bidirectional Long Short-Term Memory (BLSTM) and attention mechanism for the extraction of most discriminative spatiotemporal features from input images, can lead to superior performance in the prediction of rTMS treatment outcome. Five brain regions named Frontal, Central, Parietal, Temporal, and occipital were assessed and the highest evaluated performance in 46 proprietary MDD subjects was acquired for the Frontal region using the TL-LSTM-Attention model based on EfficientNetB0 with accuracy, sensitivity, specificity, and Area Under the Curve (AUC) of 97.1%, 97.3%, 97.0%, and 0.96 respectively. Additionally, to test the generalizability of the proposed models, these TL-BLSTM-Attention models were evaluated on a public dataset called TDBRAIN and the highest accuracy of 82.3%, the sensitivity of 80.2%, the specificity of 81.9% and the AUC of 0.83 were obtained. Therefore, advanced deep learning methods using a time-frequency representation of EEG signals from the frontal brain region and the convolutional recurrent neural networks equipped with the attention mechanism can construct an accurate platform for the prediction of response to the rTMS treatment.

Plexiform neurofibromatosis of the bladder leading to cystectomy: A rare complication of von Recklinghausen disease.

We report a 20-year-old man with neurofibromatosis type 1 presenting with frequent episodes of suprapubic pain. The episodes started 6 months ago, occurred 1 h a day, and were not related to urination. A prostate-sparing cystectomy with orthotopic diversion was performed. Histopathological assessment of the specimen confirmed bladder plexiform neurofibromatosis.

Evaluation of the efficacy of oxidized cellulose (surgicel) in reducing blood loss in suprapubic simple open prostatectomy: A randomized clinical trial.

Background: Simple open prostatectomy is still the treatment of choice for removing large prostates; however, peri-surgical bleeding accompanied by this technique has always been a challenge for urologist surgeons. Therefore, the present study aimed to investigate the effect of surgicel on reducing bleeding in trans-vesical prostatectomy. Materials and Methods: The present double-blinded clinical trial included 54 patients with Benign Prostatic Hyperplasia (BPH), divided into two groups of 27, and underwent trans-vesical prostatectomy. After removing the prostate, the prostate adenoma was weighed in the first group. Then, two surgicel were inserted into the prostate loge for prostate adenomas weighing 75 g or less. For larger prostates, another surgicel was inserted for each 25 g weight higher than the limit of 75 g. However, no Surgicel was inserted in the control group. Other steps of the procedure were the same in both groups. Moreover, hemoglobin and hematocrit levels were assessed in both groups; preoperation, intra-operative, 24 h, and 48 h postoperative. In addition, all the fluid used for bladder irrigation was collected, and its hemoglobin level was assessed. Results: According to our results, no intergroup difference in hemoglobin level changes, hematocrit changes, International Prostate Symptom Score (IPSS), postoperative hospital stay, and number of packed cells received. However, the postoperative blood loss in bladder lavage fluid was significantly higher in the control group (120.83 ± 46.66 g) as compared to the surgicel group (72.56 ± 32.53 g) (P < 0.001). Conclusion: The present study concluded that using surgicel in trans-vesical prostatectomy could reduce postoperative bleeding without increasing the chance of postoperative complications.

Comparison of intravenous sedation with propofol, dexmedetomidine and midazolam in double-J ureteral stent removal.

BACKGROUND: According to the favorable effects of combination therapy to provide better sedation during double-j stent removal and lack of studies investigating the sedative effect of propofol, dexmedetomidine, and midazolam during this procedure. This study aimed to compare the effects of intravenous sedation with propofol, dexmedetomidine and midazolam in double-J ureteral stent removal. METHODS: This double-blinded randomized clinical trial was conducted on 120 patients aged 18-72 who underwent double-J ureteral stent removal in Alzahra hospital, Isfahan, Iran from September to November 2021. Patients were randomly divided into 3 groups. In the first group, propofol was titrated with normal saline and was infused with a loading dose of 0.5 mg/kg and a maintenance dose of 1.5-2.5 mg/kg/h. In the second group, Dexmedetomidine was titrated with normal saline and was infused at a dose of 1 µg/kg within 10 min and then continued at 0.45-0.55 µg/kg. In third group, midazolam was titrated was infused with a loading dose of 0.05 mg/kg and a maintenance dose of 0.05 mg/kg/h. 50 mg of fentanyl was also infused in all the groups. If the patients did not reach the desired sedation level, 10 mg ketamine was infused as a rescue sedative agent for all three groups and repeated if needed in all groups. RESULTS: The current study was conducted on 120 patients who underwent double-J ureteral stent removal. The comparison of the sedative effect of midazolam, dexmedetomidine, and propofol showed significant differences among the three groups and was higher in the midazolam group (P=0.018). Between the three groups systolic blood pressure and mean arterial pressure was significantly lower in the propofol group (P=0.002). Heart rate was significantly lower in the dexmedetomidine group during both surgery and recovery time (P<0.001). There was no significant difference among the groups during surgery regarding oxygen saturation (P value =0.84). The intergroup comparison indicates that the mean score of surgeon satisfaction is significantly higher in the midazolam group (P-value =0.039). CONCLUSION: According to this study midazolam was superior to two other groups and was associated with deeper sedation and higher satisfaction among both patient and surgeon.